Mutant factor viii compositions and methods

ABSTRACT

In one aspect, present invention provides a recombinant mutant human factor VIII having increased expression and/or secretion as compared to wild-type factor VIII. In certain embodiments, the recombinant factor VIII includes one or more amino acid substitution(s) selected from the group consisting of 186, Y105, A108, D115, Q117, F129, G132, H134, M147 and L152. In other aspects, the present invention provides FVIII encoding nucleic acids, FVIII-expression vectors, as well as methods of using the modified FVIII genes in the treatment of FVIII deficiencies, such as hemophilia A.

This application is a continuation application of U.S. application Ser.No. 14/893,878, filed Nov. 24, 2015, which is a National StageApplication of International Application PCT/US2014/043777, filed Jun.24, 2014, which claims priority to U.S. Provisional Patent ApplicationNo. 61/838,867, filed on Jun. 24, 2013. The entirety of theaforementioned applications are incorporated herein by reference.

GOVERNMENT LICENSE RIGHTS

This invention was made with U.S. government support under grantHL084381 awarded by the National Institutes of Health. The U.S.government thus may have certain license rights in this invention.

SEQUENCE LISTING

This application contains a Sequence Listing which has been submitted inASCII format via EFS-Web and is hereby incorporated by reference hereinin its entirety. The ASCII text file was created on Sep. 13, 2018, isnamed Sequence.txt and is 81,419 bytes in size.

FIELD

The present invention relates to recombinant human factor VIII mutantsexhibiting higher expression levels than the corresponding wild-typehuman factor VIII. The present invention also relates to methods ofmaking and using the recombinant human factor VIII mutants.

BACKGROUND

Hemophilia A, the most common of the severe, inherited bleedingdisorders, results from a deficiency or defect in the plasma proteinfactor VIII. In patients with Hemophilia A, the blood does not clotproperly resulting in excessive bleeding when the hemophiliac isinjured. Treatment consists of replacement therapy using preparations of(purified) plasma or the recombinant protein. Blood clotting begins whenplatelets adhere to the cut wall of an injured blood vessel at a lesionsite. Subsequently, in a cascade of enzymatically regulated reactions,soluble fibrinogen molecules are converted by the enzyme thrombin toinsoluble strands of fibrin that hold the platelets together in athrombus. At each step in the cascade, a protein precursor is convertedto a protease that cleaves the next protein precursor in the series.Cofactors are required at most of the steps.

Factor VIII circulates as an inactive, non-covalent, metal ion-dependentheterodimer precursor in blood, bound tightly and non-covalently to vonWillebrand factor. This procofactor form of the protein contains a heavychain (HC) comprised of A1(a1)A2(a2)B domains and a light chain (LC)comprised of (a3)A3C1C2 domains, with the lower case a representingshort (˜30-40 residue) segments rich in acidic residues. Factor VIII isproteolytically activated by proteolytic cleavages at the A1 A2, A2B andA3A3 junctions catalyzed by thrombin or factor Xa, which serves todissociate it from von Willebrand factor and activate its procoagulantfunction in the cascade. In its active form, the protein factor VIIIa isa cofactor that increases the catalytic efficiency of the serineprotease factor IXa in the membrane-dependent conversion of zymogenfactor X to the serine protease, factor Xa factor by several orders ofmagnitude.

Gene therapy has been proposed as treatment modality for supplementingdeficiencies in clotting factors in hemophiliacs and there have beenattempts to engineer FVIII constructs that are suitable for treatment ofhumans. For example, Connelly, et al. reported that treatment ofFVIII-deficient mice with human FVIII-encoding adenoviral vectorsresulted in expression of biologically active human FVIII (Connelly, etal., Blood, Vol. 91, No. 9 (1998), pp. 3273-3281). Sarkar, et al.reported that use of AAV8 serotype in combination with FVIII correctedplasma FVIII activity in mouse models (Sarkar, et al., Blood, Vol. 103,No. 4 (2004), pp. 1253-1260).

However, as in many areas of gene therapy, theory is much morestraightforward than successful, effective implementation. Difficultiesin implementation of gene therapy techniques include problemsencountered in the use of viruses as gene vectors and insufficientexpression levels of FVIII. For example, human FVIII secretes veryinefficiently and the yield is logs lower comparing to similar proteinssuch as factor V. Further, while viruses are effective as gene vectorsbecause they can be used to transduce cells leading to proteinexpression in vivo, the proteins coating the virus particle may activatethe body's immune system.

Thus, in view of the foregoing, there is a need for approaches that canefficiently express the target FVIII protein in sufficient quantity toreduce the required dose of viral vector to tolerable levels.

SUMMARY

The present invention provides modified factor VIII (FVIII) proteins,FVIII encoding nucleic acids, and FVIII-expression vectors, as well asmethods of using the modified FVIII genes in the treatment of FVIIIdeficiencies, such as hemophilia A.

In one aspect, present invention provides a mutant human factor VIIIhaving increased expression or secretion as compared to wild-type factorVIII.

In one embodiment, the recombinant mutant human factor VIII includes oneor more amino acid substitution(s) selected from the group consisting ofI86, Y105, A108, D115, Q117, F129, G132, H134, M147, L152 andcombinations thereof.

In another embodiment, the recombinant mutant human factor VIII includesone or more amino acid substitution(s) selected from the groupconsisting of I86V, Y105F, A108S, D115E, Q117H, F129L, G132K, H134Q,M147T, L152P and combinations thereof.

In another embodiment, the recombinant mutant human factor VIII includesamino acid substitutions in each of the amino acids I86, Y105, A108,D115, Q117, F129, G132, H134, M147 and L152.

In another embodiment, the recombinant mutant human factor VIII includesthe amino acid substitutions I86V, Y105F, A108S, D115E, Q117H, F129L,G132K, H134Q, M147T and L152P.

In another embodiment, the recombinant mutant human factor VIII includesone or more amino acid substitution(s) selected from the groupconsisting of I86, A108, G132, M147, L152 and combinations thereof.

In another embodiment, the recombinant mutant human factor VIII includesone or more amino acid substitution(s) selected from the groupconsisting of I86V, A108S, G132K, M147T, L152P and combinations thereof.

In another embodiment, the recombinant mutant human factor VIII includesamino acid substitutions in each of I86V, A108S, G132K, M147T and L152P.

In another embodiment, the recombinant mutant human factor VIII includesthe amino acid substitutions I86V, A108S, G132K, M147T and L152P.

In other embodiments, the human factor VIII mutants further include adeletion in the B domain of human factor VIII.

In other embodiments, the human factor VIII mutants further include thea2 and/or a3 domain(s) of human factor VIII.

In another aspect, the present invention provides isolatedpolynucleotide sequences encoding the human factor VIII mutantsdescribed herein.

In yet another aspect, the present invention provides an expressionvector operatively linked to the polynucleotides encoding the humanfactor VIII mutants described herein.

In a further aspect, the present invention provides a pharmaceuticalcomposition comprising an expression vector operatively linked to thepolynucleotides encoding the human factor VIII mutants described herein.

In another aspect, the present invention provides a method for treatinga patient with a factor VIII deficiency comprising administering to apatient in need thereof a pharmaceutical composition comprising anexpression vector operatively linked to the polynucleotides encoding ahuman factor VIII mutant described herein in an amount effective fortreating the factor VIII deficiency.

In yet another aspect, the present invention provides a method forexpressing a human factor VIII polypeptide mutant comprising: (a)transforming a host cell with an expression vector operatively linked toa polynucleotides encoding a human factor VIII mutant according to thepresent invention; (b) growing the host cell under conditions suitablefor expressing the human factor VIII polypeptide mutant; and (c)purifying the human factor VIII polypeptide mutant from host cellsexpressing said mutant.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 illustrates the structural domains of the human factor VIII heavyand light chains, including several heavy chain constructions utilizedin the present invention.

FIG. 2 is a graph showing an alignment of the first 200 amino acids ofthe secreted human factor VIII heavy chain alongside a modified factorVIII with 10 exemplary substitutions for enhanced secretion.

FIG. 3 is a graph showing the alignment of the first 200 amino acids ofthe secreted human factor VIII heavy chain alongside a modified humanfactor VIII mutant with 5 exemplary substitutions for enhancedsecretion.

FIG. 4 summarizes exemplary amino acids determined to affect humanfactor VIII secretion.

FIGS. 5 and 6 depict exemplary AAV vectors for expressing B-domaindeleted human factor VIII mutants or human factor VIII heavy chain.

FIG. 7 shows a comparison of the secretion of different human factorVIII mutants in BHK cells (panel A) or 293 cells (panel B).

FIG. 8 shows a comparison of the secretion of different human factorVIII mutants in secretion in vivo. Plasmids pAAV-CB-hBDDF8 (carryinghuman factor VIII with B-domain deleted), pAAV-CB-hBDDF8-X10 (carryinghF8-BDD with 10 substitutions), pAAV-CB-hBDD-F8-X5 (carrying hBDDF8 with5 substitutions) or pAAV-CB-hBDD-F8-G3 1 2K (hF8 with G132Ksubstitutions) were injected in factor VIII double knock-out Balb/cmice.

FIG. 9 show a comparison of the secretion of different human factor VIIImutants in 293 cells. Amino acids in hBDD-F8-X10 were reverted back totheir corresponding wild type amino acids. In hBDD-F8-X10-6p, 6 of 10amino acids in hBDD-F8-X10 differing from wild type F8 were revertedback to their wild type amino acids.

FIG. 10 shows a comparison of the expression and secretion of a mutantfactor VIII (F8) heavy chain (HC1690-X10) in an AAV vector constructwith a wild type hF8-HC1690 AAV vector construct (AAV/hF8HC1690) invivo.

FIG. 11 shows a comparison of the secretion of different G132 factorVIII heavy chain mutants in 293 cells.

FIG. 12 shows a comparison of the secretion of different factor VIIIheavy chain mutants in expression/secretion in factor VIII doubleknock-out Balb/c mice.

FIG. 13 shows a comparison of the secretion of different L152 factorVIII heavy chain mutants in 293 cells.

FIG. 14 shows a comparison of the secretion of different A108 factorVIII heavy chain mutants in 293 cells.

FIG. 15 shows a comparison of the secretion of different M147 factorVIII heavy chain mutants in 293 cells.

FIG. 16 shows that there was no formation of neutralizing antibodiesagainst 5 mutated amino acids in the F8−/− rat model.

DETAILED DESCRIPTION

Various terms relating to the biological molecules of the presentinvention are used hereinabove and also throughout the specification andclaims.

The phrase “secretion enhanced factor VIII (seFVIII, seF8)” refers to amodified FVIII (F8) which has been genetically altered such that theencoded protein exhibits at least 10% or 20% or 50% or 100% increase insecretion when compared to unmodified FVIII. The nucleotide sequencesdescribed herein are readily obtainable from GenBank. For human FVIII,see Accession No. NG-011403.1.

The phrase “BDD” refers to a “B-domainless” factor VIII (F8 or FVIII)mutant lacking the B domain.

The phrase “one or more” followed by a list of elements or species isintended to encompass any permutation of elements or species in thelist. Thus, for example, the phrase “one or more substitution mutationsselected from the group consisting of A, B, C, D, E and F” may includeany combination of substitution mutations containing A, B, C, D, Eand/or F.

As used herein, ranges may be expressed from one particular integervalue to another particular integer value. When such a range isexpressed, it should understand that any and all integer values withinthat range define separate embodiments according to the presentinvention and that the full scope of embodiments includes within therange further includes any and all sub-ranges between any pair ofinteger values in the initial range.

With reference to nucleic acids of the invention, the term “isolatednucleic acid”, when applied to DNA, refers to a DNA molecule that isseparated from sequences with which it is immediately contiguous (in the5′ and 3′ directions) in the naturally occurring genome of the organismfrom which it originates. For example, the “isolated nucleic acid” maycomprise a DNA or cDNA molecule inserted into a vector, such as aplasmid or virus vector, or integrated into the DNA of a prokaryote oreukaryote. The nucleic acid codons can be optimized for enhancedexpression in the mammalian cells.

With respect to RNA molecules of the invention, the term “isolatednucleic acid” primarily refers to an RNA molecule encoded by an isolatedDNA molecule as defined above. Alternatively, the term may refer to anRNA molecule that has been sufficiently separated from RNA moleculeswith which it would be associated in its natural state (i.e., in cellsor tissues), such that it exists in a “substantially pure” form (theterm “substantially pure” is defined below).

With respect to protein, the term “isolated protein” or “isolated andpurified protein” is sometimes used herein. This term refers primarilyto a protein produced by expression of an isolated nucleic acid moleculeof the invention. Alternatively, this term may refer to a protein whichhas been sufficiently separated from other proteins with which it wouldnaturally be associated, so as to exist in “substantially pure” form.

The term “promoter region” refers to the transcriptional regulatoryregions of a gene, which may be found at the 5′ or 3′ side of the codingregion, or within the coding region, or within introns.

The term “vector” refers to a small carrier DNA molecule into which aDNA sequence can be inserted for introduction into a host cell where itwill be replicated. An “expression vector” is a specialized vector thatcontains a gene or nucleic acid sequence with the necessary regulatoryregions needed for expression in a host cell.

The term “operably linked” means that the regulatory sequences necessaryfor expression of a coding sequence are placed in the DNA molecule inthe appropriate positions relative to the coding sequence so as toeffect expression of the coding sequence. This same definition issometimes applied to the arrangement of coding sequences andtranscription control elements (e.g., promoters, enhancers, andtermination elements) in an expression vector. This definition is alsosometimes applied to the arrangement of nucleic acid sequences of afirst and a second nucleic acid molecule wherein a hybrid nucleic acidmolecule is generated.

The term “substantially pure” refers to a preparation comprising atleast 50-60% by weight the compound of interest (e.g., nucleic acid,oligonucleotide, protein, etc.). More preferably, the preparationcomprises at least 75% by weight, and most preferably 90-99% by weight,of the compound of interest. Purity is measured by methods appropriatefor the compound of interest (e.g., chromatographic methods, agarose orpolyacrylamide gel electrophoresis, HPLC analysis, and the like).

The phrase “consisting essentially of when referring to a particularnucleotide sequence or amino acid sequence means a sequence having theproperties of a given SEQ ID NO. For example, when used in reference toan amino acid sequence, the phrase includes the sequence per se andmolecular modifications that would not affect the basic and novelcharacteristics of the sequence.

The term “oligonucleotide,” as used herein refers to primers and probesof the present invention, and is defined as a nucleic acid moleculecomprised of two or more ribo- or deoxyribonucleotides, preferably morethan three. The exact size of the oligonucleotide will depend on variousfactors and on the particular application for which the oligonucleotideis used. The term “probe” as used herein refers to an oligonucleotide,polynucleotide or nucleic acid, either RNA or DNA, whether occurringnaturally as in a purified restriction enzyme digest or producedsynthetically, which is capable of annealing with or specificallyhybridizing to a nucleic acid with sequences complementary to the probe.A probe may be either single-stranded or double-stranded. The exactlength of the probe will depend upon many factors, includingtemperature, source of probe and method of use. For example, fordiagnostic applications, depending on the complexity of the targetsequence, the oligonucleotide probe typically contains 15-25 or morenucleotides, although it may contain fewer nucleotides.

The term “percent identical” is used herein with reference tocomparisons among nucleic acid or amino acid sequences. Nucleic acid andamino acid sequences are often compared using computer programs thatalign sequences of nucleic or amino acids thus defining the differencesbetween the two. Comparisons of nucleic acid sequences may be performedusing the GCG Wisconsin Package version 9.1, available from the GeneticsComputer Group in Madison, Wis. For convenience, the default parameters(gap creation penalty=12, gap extension penalty=4) specified by thatprogram are intended for use herein to compare sequence identity.Alternately, the Blastn 2.0 program provided by the National Center forBiotechnology Information (found on the world wide web atncbi.nlm.nih.gov/blast/; Altschul, et al., 1990, J Mol Biol 215:403-410)using a gapped alignment with default parameters, may be used todetermine the level of identity and similarity between nucleic acidsequences and amino acid sequences.

A “corresponding” nucleic acid or amino acid or sequence of either, asused herein, is one present at a site in a factor VIII or hybrid factorVIII molecule or fragment thereof that has the same structure and/orfunction as a site in the factor VIII molecule of another species,although the nucleic acid or amino acid number may not be identical. Asequence “corresponding to” another factor VIII sequence substantiallycorresponds to such sequence, and hybridizes to the human factor VIIIDNA sequence designated SEQ ID NO:1 under stringent conditions. Asequence “corresponding to” another factor VIII sequence also includes asequence that results in the expression of a factor VIII or claimedprocoagulant hybrid factor VIII or fragment thereof and would hybridizeto a nucleic molecule comprising SEQ ID NO:1 but for the redundancy ofthe genetic code.

A “unique” amino acid residue or sequence, as used herein, refers to anamino acid sequence or residue in the factor VIII molecule of onespecies that is different from the homologous residue or sequence in thefactor VIII molecule of another species.

“Specific activity,” as used herein, refers to the activity that willcorrect the coagulation defect of human factor VIII-deficient plasma.Specific activity is measured in units of clotting activity permilligram total factor VIII protein in a standard assay in which theclotting time of human factor VIII deficient plasma is compared to thatof normal human plasma. One unit of factor VIII activity is the activitypresent in one milliliter of normal human plasma. In the assay, theshorter the time for clot formation, the greater the activity of thefactor VIII being assayed. Hybrid human/porcine factor VIII hascoagulation activity in a human factor VIII assay. This activity, aswell as that of other hybrid or hybrid equivalent factor VIII moleculesor fragments thereof, may be less than, equal to, or greater than thatof either plasma-derived or recombinant human factor VIII.

“Subunits” of human or animal factor VIII, as used herein, are the heavyand light chains of the protein. The heavy chain of factor VIII containsthree domains, A1, A2, and B. The light chain of factor VIII alsocontains three domains, A3, C1, and C2.

The terms “epitope”, “antigenic site”, and “antigenic determinant”, asused herein, are used synonymously and are defined as a portion of thehuman, animal, hybrid, or hybrid equivalent factor VIII or fragmentthereof that is specifically recognized by an antibody. It can consistof any number of amino acid residues, and it can be dependent upon theprimary, secondary, or tertiary structure of the protein. In accordancewith this disclosure, a hybrid factor VIII, hybrid factor VIIIequivalent, or fragment of either that includes at least one epitope maybe used as a reagent in the diagnostic assays described below. In someembodiments, the hybrid or hybrid equivalent factor VIII or fragmentthereof is not cross-reactive or is less cross-reactive with allnaturally occurring inhibitory factor VIII antibodies than human orporcine factor VIII.

The term “immunogenic site”, as used herein, is defined as a region ofthe human or animal factor VIII, hybrid or hybrid equivalent factorVIII, or fragment thereof that specifically elicits the production ofantibody to the factor VIII, hybrid, hybrid equivalent, or fragment in ahuman or animal, as measured by routine protocols, such as immunoassay,e.g., ELISA, or the Bethesda assay, described herein. It can consist ofany number of amino acid residues, and it can be dependent upon theprimary, secondary, or tertiary structure of the protein. In someembodiments, the hybrid or hybrid equivalent factor VIII or fragmentthereof is nonimmunogenic or less immunogenic in an animal or human thanhuman or porcine factor VIII.

“Factor VIII deficiency,” as used herein, includes deficiency inclotting activity caused by production of defective factor VIII, byinadequate or no production of factor VIII, or by partial or totalinhibition of factor VIII by inhibitors. Hemophilia A is a type offactor VIII deficiency resulting from a defect in an X-linked gene andthe absence or deficiency of the factor VIII protein it encodes.

In one aspect, the present invention relates to a recombinant factorVIII mutant molecule (e.g., protein or nucleic acid) characterized byincreased expression and/or secretion as compared to wild-type factorVIII.

Exemplary human factor VIII cDNA (nucleotide) and predicted amino acidsequences are shown in SEQ ID NOs: 1 and 2, respectively. Human factorVIII is synthesized and secreted as an approximately 300 kDa singlechain protein of 2332 amino acids with internal sequence homologiesdefining a series of structural “domains” as follows:NH2-A1-a1-A2-a2-B-a3-A3-C1-C2-COOH (FIG. 4). As used herein, a factorVIII “domain” is defined by a continuous sequence of amino acidscharacterized by e.g., internal amino acid sequence identity tostructurally related domains and by sites of proteolytic cleavage bythrombin. Further, the terms “domainless” or “lacking a domain” shouldbe understood to mean that at least 95% or 100% of the domain has beendeleted. Unless otherwise specified, factor VIII domains are defined bythe following amino acid residues in the human factor VIII amino acidsequence set forth in SEQ ID NO:2:

A1, residues Ala1-Arg372

A2, residues Ser373-Arg740

B, residues Ser741-Arg1648;

a3, residues P1640-Arg1649;

A3, residues Ser1690-Ile2032;

C1, residues Arg2033-Asn2172; and

C2, residues Ser2173-Tyr2332

The A3-C1-C2 sequence includes residues Ser1690-Tyr2332. The remainingsequence, residues Glu1649-Arg1689, is usually referred to as the factorVIII light chain activation peptide (FIG. 1). Factor VIII isproteolytically activated by thrombin or factor Xa, which dissociates itfrom von Willebrand factor, forming factor VIIIa, which has procoagulantfunction. The biological function of factor VIIIa is to increase thecatalytic efficiency of factor IXa toward factor X activation by severalorders of magnitude. Thrombin-activated factor Villa is a 160 kDaA1/A2/A3-C1-C2 heterotrimer that forms a complex with factor IXa andfactor X on the surface of platelets or monocytes.

A cDNA sequence encoding the wild-type human factor VIII has thenucleotide sequence set forth in SEQ ID NO:1. In SEQ ID NO:1, the first57 nucleotides of the factor VIII open reading frame encodes a signalpeptide sequence which is typically cleaved off from the mature factorVIII protein represented by SEQ ID NO:2.

Preferred recombinant factor VIII mutants include or encode one or moreamino acid substitutions in the region from as 86 to as 152 of thewild-type human factor VIII amino acid sequence set forth in SEQ IDNO:2. Substitutions within any of these positions may employ any of theother 19 amino acids.

With reference to mutants described herein, the notion represented by“(amino acid a)-(SEQ ID NO:2 amino acid #b)-(amino acid c)” should beunderstood to mean that wild type amino acid a (one-letter code) atamino acid number b of SEQ ID NO:2 has been mutated to amino acid c.

In certain preferred embodiments, the human factor VIII polypeptidemutant comprises amino acid substitution(s) in one or more amino acidsin SEQ ID NO:2 selected from the group consisting of I86, Y105, A108,D115, Q117, F129, G132, H134, M147 and L152. Further, the human factorVIII mutants may include any permutation of mutations encompassing theseten amino acid sites. Exemplary human factor VIII mutants are describedin FIG. 4.

An exemplary recombinant factor VIII of this invention includes a pointmutation involving a substitution at I86 of SEQ ID NO:2. A preferredsubstitution includes valine (i.e., I86V). Further preferredsubstitutions include leucine (I86L) and methionine (I86M).

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution at Y105 of SEQ ID NO:2. The substitution mayinclude any of the other 19 amino acids. Preferred substitutions includeY105F and Y105W.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions A108 of SEQ ID NO:2. Apreferred substitution includes: A108S. Further preferred substitutionsinclude A108S, A108G, A108T and A108P.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions D115 of SEQ ID NO:2. Apreferred substitution includes: D115E. Further preferred substitutionsinclude D115N, D115H, D115Q, D115R and D115K.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions Q117 of SEQ ID NO:2. Apreferred substitution includes: Q117H. Further preferred substitutionsinclude Q117N, Q117E, Q117D, Q117R and Q117K.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions F129 of SEQ ID NO:2. Apreferred substitution include: F129L. Further preferred substitutionsinclude F129V, F129I, F129M, F129P, F129T and F129K.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions G132 of SEQ ID NO:2. Apreferred substitution include: G132K. Further preferred substitutionsinclude G132E, G132D, G132R, G132T, G132M, G132N, G132S and G132W.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions H134 of SEQ ID NO:2. Apreferred substitution includes: H134Q. Further preferred substitutionsinclude H134G, H134Y, H134N, H134E, H134D, H134R and H134K.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions M147 of SEQ ID NO:2. Apreferred substitution includes: M147T. Further preferred substitutionsinclude M147A, M147G, M147S and M147P.

Another exemplary recombinant factor VIII includes a point mutationinvolving a substitution of at positions L152 of SEQ ID NO:2. Apreferred substitution includes: L152P. Further preferred substitutionsinclude L152S, L152G and L152T.

Another exemplary recombinant factor VIII includes multiplesubstitutions of one or more amino acid residues at positions I86, A108,G132, M147, L152 of SEQ ID NO:2. The substitution(s) can include anypermutation of mutations encompassing these five amino acid sites.Specific embodiments may include mutations at one or more substitutionmutations selected from the group consisting of I86V, A108S, G132K,M147T, L152P. Further preferred embodiments include 2, 3, 4 or 5substitutions, including any combination (or permutation) ofsubstitutions selected from I86V, A108S, G132K, M147T and L152P.

Exemplary recombinant factor VIII mutants include point mutation(s)involving substitution(s) at one or more amino acid residues in SEQ IDNO:2 selected from the group consisting of I86, Y105, A108, D115, Q117,F129, G132, H134, M147 and L152. The substitution(s) can include anypermutation of mutations encompassing these ten amino acid sites.Specific embodiments may include mutations at one or more substitutionmutations selected from the group consisting of I86V, Y105F, A108S,D115E, Q117H, F129L, G132K, H134Q, M147T and L152P. Further preferredembodiments include 2, 3, 4 or up to 9 substitutions, including anycombination (or permutation) of substitutions selected from I86V, Y105F,A108S, D115E, Q117H, F129L, G132K, H134Q, M147T and L152P.

The nucleic acids encoding the above mentioned factor VIII substitutionsare included in this invention and include all possible nucleic acidsencoding the breadth of substitution mutants described herein.

Compared to wild type factor VIII in production (in cell lines or invivo), the above described factor VIII mutants may exhibit increases infactor VIII secretion of between 5% to 10,000 fold, 10% to 2,000 fold,50% up to 500 fold, 2 to 200 fold, 5 to 100 fold, 10 to 50 fold, atleast 2 fold, at least 5 fold, at least 10 fold, at least 20 fold, atleast 50 fold, at least 100 fold, at least 200 fold, at least 500 fold,at least 2,000 fold or at least 10,000 fold.

In certain embodiments, suitable mutant factor VIII sequences may befurther modified to include, delete, or modify other factor VIIIsequences to confer properties with regard to other attributes,including, without limitation, antigenicity, circulating half-life,protein secretion, affinity for factor IXa and/or factor X, alteredfactor VIII-inactivation cleavage sites, stability of the activatedfactor VIII form, immunogenicity, and shelf-life.

In certain specific embodiments, the mutant factor VIII may be modifiedto produce a B-domain deleted (BDD) or “B-domainless” factor VIIIproduct. FIG. 1 shows an exemplary BDD factor VIII embodiment containingamino acid residues 1-740 and 1690-2332 of SEQ ID NO:2. Preferably, therecombinant B-domainless factor VIII contains one or multiplesubstitutions at positions I86, Y105, A108, D115, Q117, F129, G132,H134, M147, L152 as described herein.

In one embodiment, a B-domainless recombinant factor VIII is produced,whereby the B-domain is replaced with a DNA linker segment and at leastone codon is replaced with a codon encoding an amino acid residue havingthe same charge as a corresponding residue of porcine factor VIII (see,e.g., U.S. Patent Application Publication No. 2004/0197875 to Hauser, etal.).

In another embodiment, a B-domainless recombinant factor VIII isproduced having a truncated factor IX intron 1 inserted in one or morelocations (see, e.g., U.S. Pat. No. 6,800,461 to Negrier and U.S. Pat.No. 6,780,614 to Negrier). This recombinant factor VIII can be used foryielding higher production of the recombinant factor VIII in vitro aswell as in a transfer vector for gene therapy (see, e.g., U.S. Pat. No.6,800,461 to Negrier). In a particular embodiment, the recombinantfactor VIII can be encoded by a nucleotide sequence having a truncatedfactor IX intron 1 inserted in two locations and having a promoter thatis suitable for driving expression in hematopoietic cell lines, andspecifically in platelets (see, e.g., U.S. Pat. No. 6,780,614 toNegrier).

A second example of a suitable mutant factor VIII that can be modifiedin accordance with the present invention is a chimeric human/animalfactor VIII that contains one or more animal amino acid residues assubstitution(s) for human amino acid residues that are responsible forthe antigenicity of human factor VIII. In particular, animal (e.g.,porcine) residue substitutions can include, without limitation, one ormore of the following: R484A, R488G, P485A, L486S, Y487L, Y487A, S488A,S488L, R489A, R489S, R490G, L491S, P492L, P492A, K493A, G494S, V495A,K496M, H497L, L498S, K499M, D500A, F501A, P502L, 1503M, L504M, P505A,G506A, E507G, 1508M, 1508A, M2199I, F2200L, L2252F, V2223A, K2227Eand/or L225I (U.S. Pat. No. 5,859,204 to Lollar, U.S. Pat. No. 6,770,744to Lollar, and U.S. Patent Application Publication No. 2003/0166536 toLollar). Preferably, the recombinant chimeric factor VIII contains oneor multiple substitutions at positions I86, Y105, A108, D115, Q117,F129, G132, H134, M147 and L152 as described herein.

In a further embodiment, the mutant factor VIII is modified to confergreater stability of activated factor VIII by virtue of fused A2 and A3domains. In particular, a factor VIII can be modified by substitutingcysteine residues at positions 664 and 1826, (i.e., Y664C, T1826C)resulting in a mutant factor VIII forming a Cys664-Cys1826 disulfidebond covalently linking the A2 and A3 domains (Gale, et al., “AnEngineered Interdomain Disulfide Bond Stabilizes Human Blood CoagulationFactor Villa,” J. Thrombosis and Haemostasis 1(9):1966-1971 (2003)).Preferably, the recombinant fused domain (A2-A3) factor VIII containsone or multiple substitutions at positions I86, Y105, A108, D115, Q117,F129, G132, H134, M147 and L152 as described herein.

In a further embodiment, a mutant factor VIII in accordance with thepresent invention (e.g., containing one or multiple substitutions atpositions I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152) is further modified to confer altered inactivation cleavage sites.For example, Arg336 or Arg562 may be substituted used to decrease themutant factor VIII's susceptibility to cleavage enzymes that normallyinactivate the wild type factor VIII (see, e.g., Amano, et al.,“Mutation at Either Arg336 or Arg562 in Factor VIII is Insufficient forComplete Resistance to Activated Protein C (APC)-Mediated Inactivation:implications for the APC Resistance Test,” Thrombosis & Haemostasis79(3):557-63 (1998)).

In a further embodiment, a mutant factor VIII in accordance with thepresent invention (e.g., containing one or multiple substitutions atpositions I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152) is further modified to confer enhanced affinity for factor IXa(see, e.g., Fay, et al., “Factor VIIIa A2 Subunit Residues 558-565Represent a Factor IXa Interactive Site,” J. Biol. Chem. 269(32):20522-7(1994); Bajaj, et al., “Factor IXa: Factor VIIIa Interaction. Helix330-338 of Factor IXa Interacts with Residues 558-565 and SpatiallyAdjacent Regions of the A2 Subunit of Factor VIIIa,” J. Biol. Chem.276(19):16302-9 (2001); and Lenting, et al., “The SequenceGlu1811-Lys1818 of Human Blood Coagulation Factor VIII Comprises aBinding Site for Activated Factor IX,” J. Biol. Chem. 271(4):1935-40(1996)) and/or factor X (see, e.g., Lapan, et al., “Localization of aFactor X Interactive Site in the A1 Subunit of Factor VIIIa,” J. Biol.Chem. 272:2082-88 (1997)).

In yet another further embodiment, a mutant factor VIII in accordancewith the present invention (e.g., containing one or multiplesubstitutions at positions I86, Y105, A108, D115, Q117, F129, G132,H134, M147 and/or L152) is further modified to further enhance secretionof factor VIII (see, e.g., Swaroop, et al., “Mutagenesis of a PotentialImmunoglobulin-Binding Protein-Binding Site Enhances Secretion ofCoagulation Factor VIII,” J. Biol. Chem. 272(39):24121-4 (1997)).

In a further embodiment, a mutant factor VIII in accordance with thepresent invention (e.g., containing one or multiple substitutions atpositions I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152) is further modified to confer increased circulating half-life.This may be achieved through various approaches, including, withoutlimitation, by reducing interactions with heparan sulfate (Sarafanov, etal., “Cell Surface Heparan Sulfate Proteoglycans Participate in FactorVIII Catabolism Mediated by Low Density Lipoprotein Receptor-RelatedProtein,” J. Biol. Chem. 276(15):11970-9 (2001)) and/or low-densitylipoprotein receptor-related protein (“LRP”) (Saenko, et al., “Role ofthe Low Density Lipoprotein-Related Protein Receptor in Mediation ofFactor VIII Catabolism,” J. Biol. Chem. 274(53):37685-92 (1999); and“The Light Chain of Factor VIII Comprises a Binding Site for Low DensityLipoprotein Receptor-Related Protein,” J. Biol. Chem. 274(34):23734-9(1999)).

An eighth example of a suitable mutant factor VIII that can be modifiedin accordance with the present invention is a modified factor VIIIencoded by a nucleotide sequence modified to code for amino acids withinknown, existing epitopes to produce a recognition sequence forglycosylation at asparagine residues (see, e.g., U.S. Pat. No. 6,759,216to Lollar). Such modification can be useful escaping detection byexisting inhibitory antibodies (low antigenicity factor VIII) anddecreasing the likelihood of developing inhibitory antibodies (lowimmunogenicity factor VIII). In one representative embodiment, themodified factor VIII is mutated to incorporate a consensus amino acidsequence for N-linked glycosylation, such as N-X-S/T (see U.S. Pat. No.6,759,216 to Lollar).

A ninth example of a suitable mutant factor VIII that can be modified inaccordance with the present invention is a modified factor VIII that isa procoagulant-active factor VIII having various mutations (see, e.g.,U.S. Patent Application Publication No. 2004/0092442 to Kaufman, etal.). One example of this embodiment relates to a modified factor VIIIthat has been modified to (i) delete the von Willebrand factor bindingsite, (ii) add a mutation at Arg 740, and (iii) add an amino acidsequence spacer between the A2- and A3-domains, where the amino acidspacer is of a sufficient length so that upon activation, theprocoagulant-active factor VIII protein becomes a heterodimer (see U.S.Patent Application Publication No. 2004/0092442 to Kaufman, et al).

Further, the mutant factor VIII can be modified to take advantage ofvarious advancements regarding recombinant coagulation factors generally(see, e.g., Saenko, et al., “The Future of Recombinant CoagulationFactors,” J. Thrombosis and Haemostasis 1:922-930 (2003)).

The recombinant factor VIII of the present invention can be modified atposition I86, Y105, A108, D115, Q117, F129, G132, H134, M147, L152, aswell as be modified to be B-domainless, to be chimeric, to have fusedA2-A3 domains, to have altered inactivation cleavage sites, to haveenhanced factor IXa and/or factor X affinity, to have enhanced specificactivity, to have an increased circulating half-life, to have mutantglycosylation sites, or to possess any two or more of such modificationsin addition to the modifications at position(s) I86, Y105, A108, D115,Q117, F129, G132, H134, M147 and/or L152.

Another aspect of the present invention relates to a method of making arecombinant factor VIII having increased specific activity compared tothat of a wild-type factor VIII. This method involves altering the aminoacid sequence of a wild-type factor VIII to yield a recombinant factorVIII. Alteration of the amino acid sequence of the wild-type factor VIIIcan include, for example, introducing at least one point mutation in ornear at least one calcium binding site of the wild-type factor VIII.Thereafter, using protein analysis techniques well-known in the art, adetermination can be made as to whether the recombinant factor VIII hasincreased specific activity compared to that of the wild-type factorVIII.

The recombinant factor VIII is preferably produced in a substantiallypure form. In a particular embodiment, the substantially purerecombinant factor VIII is at least about 80% pure, more preferably atleast 90% pure, most preferably at least 95% pure, 98% pure, 99% pure or99.9% pure. A substantially pure recombinant factor VIII can be obtainedby conventional techniques well known in the art. Typically, thesubstantially pure recombinant factor VIII is secreted into the growthmedium of recombinant host cells. Alternatively, the substantially purerecombinant factor VIII is produced but not secreted into growth medium.In such cases, to isolate the substantially pure recombinant factorVIII, the host cell carrying the recombinant plasmid is propagated,lysed by sonication, heat, or chemical treatment, and the homogenate iscentrifuged to remove cell debris. The supernatant is then subjected tosequential ammonium sulfate precipitation. The fraction containing thesubstantially pure recombinant factor VIII is subjected to gelfiltration in an appropriately sized dextran or polyacrylamide column toseparate the recombinant factor VIII. If necessary, a protein fraction(containing the substantially pure recombinant factor VIII) may befurther purified by high performance liquid chromatography (“HPLC”).

Another aspect of the present invention relates to an isolated nucleicacid molecule that encodes a recombinant mutant factor VIII as describedherein. The isolated nucleic acid molecule encoding the recombinantmutant factor VIII can be an RNA or DNA. The nucleic acid codons can befurther optimized for enhanced expression.

In one embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding the amino acid sequence of SEQ ID NO:2 asmodified with one of the substitutions at positions identified in thisinvention (i.e., possessing one to three nucleotide substitutions withincodon 86 (nt256-258), codon 105 (nt:313-315), codon 108 (nt:322-324),codon 115 (nt:343-345), codon 117 (nt:349-351), codon 129 (nt:385-387),codon 132 (nt:394-396), codon 134 (nt:400-402), codon 147 (nt:439-441)and/or codon 152 (nt:454-456) of SEQ ID NO:1 (the first 57 nucleotidesare not counted since they encode the signal peptides). The isolatednucleic acid molecule may have one or multiple changes in thesepositions in any combination.

In another embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a B-domainless factor VIII of the typedescribed above, as modified with one or multiple substitutions atposition(s) I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152.

In another embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a chimeric human/porcine of the typedescribed above, as modified with one or multiple substitutions atposition(s) I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152.

In a further embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a fused A2-A3 domain factor VIII of thetype described above, as modified with one or multiple substitutions atposition(s) I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152.

In another embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a factor VIII whose inactivation sites havebeen modified as described above, as further modified with one ormultiple substitutions at position(s) I86, Y105, A108, D115, Q117, F129,G132, H134, M147 and/or L152.

In yet another embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a factor VIII whose affinity for factor IXaand/or factor X has been enhanced, along with one or multiplesubstitutions at position(s) I86, Y105, A108, D115, Q117, F129, G132,H134, M147 and/or L152.

In a still further embodiment, the isolated nucleic acid molecule canhave a nucleotide sequence encoding a factor VIII whose affinity forvarious serum-binding proteins has been altered to increase itscirculating half-life and further modified with one or multiplesubstitutions at position(s) I86, Y105, A108, D115, Q117, F129, G132,H134, M147 and/or L152.

In a further embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a factor VIII that has increased secretionin culture, as further modified with one or multiple substitutions atposition(s) I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152.

In a further embodiment, the isolated nucleic acid molecule can have anucleotide sequence encoding a factor VIII that possesses one or morenon-naturally occurring glycosylation site(s) along with one or multiplesubstitutions at position(s) I86, Y105, A108, D115, Q117, F129, G132,H134, M147 and/or L152.

In yet another embodiment, the isolated nucleic acid molecule encodes arecombinant factor VIII that is modified with one or more substitutionsat position(s) I86, Y105, A108, D115, Q117, F129, G132, H134, M147and/or L152 and is further modified to possess any combination of thefollowing modification: modified to be B-domainless, modified to bechimeric, modified to have fused A2-A3 domains, modified to have one ormore altered inactivation cleavage site(s), modified to have enhancedfactor IXa and/or factor X affinity, modified to have enhancedsecretion, modified to have an increased circulating half-life, andmodified to possess one or more non-naturally occurring glycosylationsite(s).

Another aspect of the present invention relates to an expression vectorfor expressing the mutant factor VIII polynucleotides described herein.As used herein, the term “expression vector” refers to a viral ornon-viral vector that comprise a polynucleotide encoding the novelpeptide of the present invention in a form suitable for expression ofthe polynucleotide in a host cell. One type of non-viral vector is a“plasmid,” which includes a circular double-stranded DNA loop into whichadditional DNA segments can be ligated. In the present specification,“plasmid” and “vector” can be used interchangeably as the plasmid is themost commonly used form of vector.

When preparing an expression vector, the transgene sequences may beinserted into a plasmid containing suitable bacterial sequences forreplication in bacterial, as well as eukaryotic cells. Any convenientplasmid may be employed, which can include markers allowing forselection in a bacterium, and generally one or more unique, convenientlylocated restriction sites. The selection of a vector will depend on thepreferred transformation technique and target host for transformation.

Expression vectors for expressing mutant factor VIII polypeptidesinclude one or more regulatory sequences operably linked to thepolynucleotide sequence to be expressed. It will be appreciated by thoseskilled in the art that the design of the expression vector can dependon such factors as the choice of the host cell to be transformed, thelevel of expression of protein desired, and the like. The expressionvectors of the invention can be introduced into host cells to therebyproduce the mutant factor VIII proteins described herein.

As used herein, the term “control sequences” or “regulatory sequences”refers to DNA sequences necessary for the expression of an operablylinked coding sequence in a particular host organism. The term“control/regulatory sequence” is intended to include promoters,enhancers and other expression control elements (e.g., polyadenylationsignals). Control/regulatory sequences include those which directconstitutive expression of a nucleotide sequence in many types of hostcells and those which direct expression of the nucleotide sequence onlyin certain host cells (e.g., tissue-specific regulatory sequences).

A nucleic acid sequence is “operably linked” to another nucleic acidsequence when the former is placed into a functional relationship withthe latter. For example, a DNA for a presequence or secretory leaderpeptide is operably linked to DNA for a polypeptide if it is expressedas a preprotein that participates in the secretion of the polypeptide; apromoter or enhancer is operably linked to a coding sequence if itaffects the transcription of the sequence; or a ribosome binding site isoperably linked to a coding sequence if it is positioned so as tofacilitate translation. Generally, “operably linked” means that the DNAsequences being linked are contiguous and, in the case of a secretoryleader, contiguous and in reading phase. However, enhancers do not haveto be contiguous. Linking is accomplished by ligation at convenientrestriction sites. If such sites do not exist, synthetic oligonucleotideadaptors or linkers are used in accordance with conventional practice.

Suitable expression vectors for directing expression in mammalian cellsgenerally include a promoter, as well as other transcription andtranslation control sequences known in the art. In certain embodiments,the mammalian expression vector is capable of directing expression ofthe polynucleotide preferentially in a particular cell type (e.g.,tissue-specific regulatory elements are used to express thepolynucleotide). Tissue-specific regulatory elements are known in theart and may include, for example, liver cell-specific promoters and/orenhancers (e.g., albumin promoter, a-I antitrypsin promoter, apoEenhancer). Alternatively, a constitutive promoter (e.g., HCMV) active invirtually any cell type may be used.

In certain preferred embodiments, the expression vectors are viralvectors. Viral vectors typically have one or more viral genes removedand include a gene/promotor cassette inserted into a viral genomeinsertion site for insertion of exogenous transgenes, including themutant factor VIII genes described herein. The necessary functions ofthe removed gene(s) may be supplied by cell lines which have beenengineered to express the gene products of the early genes in trans.Exemplary viral vectors include, but are not limited to,adeno-associated viral (AAV) vectors, retroviral vectors, includinglentiviral vectors, adenoviral vectors, herpes viral vectors, andalphavirus vectors. Other viral vectors include astrovirus, coronavirus,orthomyxovirus, papovavirus, paramyxovirus, parvovirus, picornavirus,poxvirus, togavirus viral vectors and the like. The viral vector maycomprise any suitable nucleic acid construct, such as a DNA or RNAconstruct and may be single stranded, double stranded, or duplexed.

Once the DNA construct of the present invention has been prepared, it isready to be incorporated into a host cell. Accordingly, another aspectof the present invention relates to a method of making a recombinantcell comprising a factor VIII nucleic acid. Basically, this entailsintroducing the DNA construct into cells via transformation,transduction, electroporation, calcium phosphate precipitation,liposomes and the like and selecting for cells that have incorporatedthe DNA episomally or integrated into the host genome.

Thus, a further aspect of the present invention relates to a host cellincluding an isolated nucleic acid molecule encoding the recombinantfactor VIII of the present invention. The host cell can contain theisolated nucleic acid molecule as a DNA molecule in the form of anepisomal plasmid or stably integrated into the host cell genome.Further, the host cell can constitute an expression system for producingthe recombinant mutant factor VIII protein. Suitable host cells can be,without limitation, animal cells (e.g., baby hamster kidney (“BHK”)cells), Chinese hamster ovary cells (“CHO”), bacterial cells (e.g., E.coli), insect cells (e.g., Sf9 cells), fungal cells, yeast cells (e.g.,Saccharomyces or Schizosaccharomyces), plant cells (e.g., Arabidopsis ortobacco cells), algal cells and the like.

Another aspect of the present invention relates to a method of making arecombinant factor VIII of the present invention. This method involvesgrowing a host cell of the present invention under conditions wherebythe host cell expresses the recombinant factor VIII. The recombinantfactor VIII is then isolated. In one embodiment, the host cell is grownin vitro in a growth medium. In a particular embodiment, suitable growthmedia can include, without limitation, a growth medium containing a vonWillebrand Factor (referred to herein as “VWF”). In this embodiment, thehost cell can contain a transgene encoding a VWF or the VWF can beintroduced to the growth medium as a supplement. VWF in the growthmedium will allow for greater expression levels of the recombinantfactor VIII. Once the recombinant factor VIII is secreted into thegrowth medium, it can then be isolated from the growth medium usingtechniques well-known by those of ordinary skill in the relevantrecombinant DNA and protein arts (including those described herein). Inanother embodiment, the method of making the recombinant factor VIII ofthe present invention further involves disrupting the host cell prior toisolation of the recombinant factor VIII. In this embodiment, therecombinant factor VIII is isolated from cellular debris.

When recombinantly produced, the factor VIII protein or polypeptide (orfragment or mutant thereof) is expressed in a recombinant host cell,typically, although not exclusively, a eukaryote. In certain preferredembodiments, eukaryotic host cells, such as mammalian cells, are used toproduce mutant factor VIII polypeptides as described herein. Mammaliancells suitable for carrying out the present invention include, amongothers: COS (e.g., ATCC No. CRL 1650 or 1651), BHK (e.g., ATCC No. CRL6281), CHO (ATCC No. CCL 61), HeLa (e.g., ATCC No. CCL 2), 293 (ATCC No.1573), CHOP, and NS-1 cells.

Another aspect of the present invention relates to a method for treatingpatient with a factor VIII deficiency. In one embodiment, this involvesadministering to a patient in need thereof a recombinant mutant factorVIII (as described herein) in an amount effective for treating thefactor VIII deficiency.

In a particular embodiment, the recombinant factor VIII, alone, or inthe form of a pharmaceutical composition (i.e., in combination withstabilizers, delivery vehicles, and/or carriers) is infused intopatients intravenously according to the same procedure that is used forinfusion of human or animal factor VIII. A suitable effective amount ofthe recombinant factor VIII can include, without limitation, betweenabout 10 to about 500 units/kg body weight of the patient.

In another embodiment, a method for treating patient with a factor VIIIdeficiency comprises administering to a patient in need thereof apharmaceutical composition comprising an expression vector encoding amutant factor VIII, or a functional fragments thereof, in an amounteffective for treating the factor VIII deficiency. In certainembodiments, the recombinant factor VIII can be administered bytransplanting cells genetically engineered to produce the recombinantfactor VIII, typically via implantation of a device containing suchcells. Such transplantation typically involves using recombinant dermalfibroblasts, a non-viral approach (Roth, et al., New Engl. J. Med.344:1735-1742 (2001)).

Administration of FVIII-encoding expression vectors to factor VIIIdeficient patients can result in sufficient expression of FVIIIpolypeptide to functionally reconstitute the coagulation cascade. Theexpression vector(s) may be administered alone or in combination withother therapeutic agents in a pharmaceutically acceptable orbiologically compatible composition.

The FVIII-encoding polynucleotide can be employed as a single chainmolecule containing both heavy and light chain portions (FIG. 10) orsplit into two or multiple molecules (e.g., heavy and light chain; FIG.11) in viral or non-viral vectors for delivery into host cells of thepatient.

In a preferred embodiment of the invention, the expression vectorcomprising nucleic acid sequences encoding the mutant FVIII mutants is aviral vector. Viral vectors which may be used in the present inventioninclude, but are not limited to, adenoviral vectors (with or withouttissue specific promoters/enhancers), adeno-associated virus (AAV)vectors of multiple serotypes (e.g., AAV-1 to AAV-12, and others) andhybrid AAV vectors, lentivirus vectors and pseudo-typed lentivirusvectors [e.g., Ebola virus, vesicular stomatitis virus (VSV), and felineimmunodeficiency virus (FIV)], herpes simplex virus vectors, vacciniavirus vectors, retroviral vectors, lentiviral vectors, non-viral vectorsand others.

In certain preferred embodiments, methods are provided for theadministration of a viral vector comprising nucleic acid sequencesencoding a mutant FVIII, or a functional fragment thereof involve theuse of AAV vectors or lentiviral vectors. Most preferably, only theessential parts of vector e.g., the ITR and LTR elements, respectivelyare included. Direct delivery of vectors or ex-vivo transduction ofhuman cells and followed by infusion into the body will result inexpression of mutant FVIIIs thereby exerting a beneficial therapeuticeffect on hemostasis by enhancing pro-coagulation activity.

Recombinant AAV and lentiviral vectors have found broad utility for avariety of gene therapy applications. Their utility for suchapplications is due largely to the high efficiency of in vivo genetransfer achieved in a variety of organ contexts. AAV and lentiviralparticles may be used to advantage as vehicles for effective genedelivery. Such virions possess a number of desirable features for suchapplications, including tropism for dividing and non-dividing cells.Early clinical experience with these vectors also demonstrated nosustained toxicity and immune responses were minimal or undetectable.AAV are known to infect a wide variety of cell types in vivo and invitro by receptor-mediated endocytosis or by transcytosis. These vectorsystems have been tested in humans targeting retinal epithelium, liver,skeletal muscle, airways, brain, joints and hematopoietic stem cells. Itis likely that non-viral vectors based on plasmid DNA or minicircleswill be also suitable gene transfer vectors for a large gene as thatencoding FVIII.

It is desirable to introduce a vector that can provide, for example,sufficient expression of a desired gene and minimal immunogenicity.Improved AAV and lentiviral vectors and methods for producing suchvectors have been described in detail in a number of references,patents, and patent applications, including Wright J. F. (Hum Gene Ther20:698-706, 2009) which describes the production of clinical gradevectors. Lentiviral vector can be produced at CHOP and the other vectorsare available through the Lentivirus vector production core laboratoryby NHLBI Gene Therapy Resource Program (GTRP)-Lentivirus VectorProduction Core Laboratory.

For some applications, an expression construct may further compriseregulatory elements which serve to drive expression in a particular cellor tissue type. Such regulatory elements are known to those of skill inthe art and discussed in depth in Sambrook, et al. (1989) and Ausubel,et al. (1992). The incorporation of tissue specific regulatory elementsin the expression constructs of the present invention provides for atleast partial tissue tropism for the expression of the mutant FVIIIs orfunctional fragments thereof. For example, nucleic acid sequencesencoding mutant FVIII under the control of a cytomegalovirus (CMV)promoter can be employed for skeletal muscle expression or the hAAT-ApoEand others for liver specific expression. Hematopoietic specificpromoters in lentiviral vectors may also be used to advantage in themethods of the present invention.

In a preferred embodiment, the mutant FVIII sequence is provided as acomponent of a viral vector packaged in a capsid. In a particularlypreferred embodiment, an AAV vector is used for in vivo delivery of themutant FVIIIs (Gnatenko, et al., Br. J. Haematol. 104:27-36 (1999)). Inthis case, the AAV vector includes at least one mutant FVIII andassociated expression control sequences for controlling expression ofthe mutant FVIII sequence. As shown in FIGS. 10 and 11, exemplary AAVvectors for expressing mutant FVIII sequences may includepromoter-enhancer regulatory regions for FVIII expression and cis-actingITRs functioning to enable promote replication and packaging of themutant FVIII nucleic acids into AAV capsids and integration of themutant FVIII nucleic acid into the genome of a target cell. Preferably,the AAV vector has its rep and cap genes deleted and replaced by themutant hFVIII sequence and its associated expression control sequences.As shown in FIGS. 10 and 11, the mutant FVIII sequence is typicallyinserted adjacent to one or two (i.e., flanked by) AAV TRs or TRelements adequate for viral replication. Other regulatory sequencessuitable for facilitating tissue-specific expression of the mutanthFVIII sequence in the target cell may also be included.

The viral capsid component of the packaged viral vectors may be aparvovirus capsid. AAV Cap and chimeric capsids are preferred. Examplesof suitable parvovirus viral capsid components are capsid componentsfrom the Parvoviridae family, such as an autonomous parvovirus or adependovirus. For example, the viral capsid may be an AAV capsid (e.g.,AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV 9, AAV10, AAV 11 orAAV12 capsid; one skilled in the art would know there are likely othervariants not yet identified that perform the same or similar function),or may include components from two or more AAV capsids. A fullcomplement of AAV Cap proteins includes VP1, VP2, and VP3. The ORFcomprising nucleotide sequences encoding AAV VP capsid proteins maycomprise less than a full complement AAV Cap proteins or the fullcomplement of AAV Cap proteins may be provided.

One or more of the AAV Cap proteins may be a chimeric protein, includingamino acid sequences AAV Caps from two or more viruses, preferably twoor more AAVs, as described in Rabinowitz et al., U.S. Pat. No.6,491,907. For example, the chimeric virus capsid can include an AAV ICap protein or subunit and at least one AAV2 Cap or subunit. Thechimeric capsid can, for example, include an AAV capsid with one or moreB19 Cap subunits, e.g., an AAV Cap protein or subunit can be replaced bya B19 Cap protein or subunit. For example, the Vp3 subunit of the AAVcapsid can be replaced by the Vp2 subunit of B19.

Packaging cells may be cultured to produce packaged viral vectors of theinvention. The packaging cells may include heterologous (1) viral vectorfunction(s), (2) packaging function(s), and (3) helper function(s). Theviral vector functions typically include a portion of a parvovirusgenome, such as an AAV genome, with rep and cap deleted and replaced bythe mutant FVIII sequence and its associated expression controlsequences as described above.

In certain embodiments, the viral vector functions may suitably beprovided as duplexed vector templates, as described in U.S. PatentPublication No. 2004/0029106 to Samulski et al. Duplexed vectors aredimeric self-complementary (sc) polynucleotides (typically, DNA). Forexample, the DNA of the duplexed vectors can be selected so as to form adouble-stranded hairpin structure due to intrastrand base pairing. Bothstrands of the duplexed DNA vectors may be packaged within a viralcapsid. The duplexed vector provides a function comparable todouble-stranded DNA virus vectors and can alleviate the need of thetarget cell to synthesize complementary DNA to the single-strandedgenome normally encapsidated by the virus.

The TR(s) (resolvable and non-resolvable) selected for use in the viralvectors are preferably AAV sequences (from any AAV serotype). ResolvableAAV ITRs need not have a wild-type TR sequence (e.g., a wild-typesequence may be altered by insertion, deletion, truncation or missensemutations), as long as the TR mediates the desired functions, e.g.,virus packaging, integration, and/or provirus rescue, and the like. TheTRs may be synthetic sequences that function as AAV inverted terminalrepeats, such as the “double-D sequence” as described in U.S. Pat. No.5,478,745 to Samulski et al. Typically, but not necessarily, the TRs arefrom the same parvovirus, e.g., both TR sequences are from AAV2.

The packaging functions include capsid components. The capsid componentsare preferably from a parvoviral capsid, such as an AAV capsid or achimeric AAV capsid function. Examples of suitable parvovirus viralcapsid components are capsid components from the family Parvoviridae,such as an autonomous parvovirus or a Dependovirus. For example, thecapsid components may be selected from AAV capsids, e.g., AAV1-AAV12 andother novel capsids as yet unidentified or from non-human primatesources. Capsid components may include components from two or more AAVcapsids.

In certain embodiments, one or more of the VP capsid proteins maycomprise chimeric proteins, comprising amino acid sequences from two ormore viruses, preferably two or more AAVs, as described in Rabinowitz etal., U.S. Pat. No. 6,491,907. For example, the chimeric virus capsid caninclude a capsid region from an adeno-associated virus (AAV) and atleast one capsid region from a B19 virus. The chimeric capsid can, forexample, include an AAV capsid with one or more B19 capsid subunits,e.g., an AAV capsid subunit can be replaced by a B19 capsid subunit. Forexample, the VP1, VP2 or VP3 subunit of the AAV capsid can be replacedby the VP1, VP2 or VP3 subunit of B19. As another example, the chimericcapsid may include an AAV type 2 capsid in which the type 2 VP1 subunithas been replaced by the VP1 subunit from an AAV type 1, 3, 4, 5, or 6capsid, preferably a type 3, 4, or 5 capsid. Alternatively, the chimericparvovirus has an AAV type 2 capsid in which the type 2 VP2 subunit hasbeen replaced by the VP2 subunit from an AAV type 1, 3, 4, 5, or 6capsid, preferably a type 3, 4, or 5 capsid. Likewise, chimericparvoviruses in which the VP3 subunit from an AAV type 1, 3, 4, 5 or 6(more preferably, type 3, 4 or 5) is substituted for the VP3 subunit ofan AAV type 2 capsid are preferred. As a further alternative, chimericparvoviruses in which two of the AAV type 2 subunits are replaced by thesubunits from an AAV of a different serotype (e.g., AAV type 1, 3, 4, 5or 6) are preferred. In exemplary chimeric parvoviruses according tothis embodiment, the VP1 and VP2, or VP1 and VP3, or VP2 and VP3subunits of an AAV type 2 capsid are replaced by the correspondingsubunits of an AAV of a different serotype (e.g., AAV type 1, 3, 4, 5 or6). Likewise, in other preferred embodiments, the chimeric parvovirushas an AAV type 1, 3, 4, 5 or 6 capsid (preferably the type 2, 3 or 5capsid) in which one or two subunits have been replaced with those froman AAV of a different serotype, as described above for AAV type 2.

The packaged viral vector generally includes the mutant FVIII sequenceand expression control sequences flanked by TR elements sufficient toresult in packaging of the vector DNA and subsequent expression of themutant FVIII sequence in the transduced cell. The viral vector functionsmay, for example, be supplied to the cell as a component of a plasmid oran amplicon. The viral vector functions may exist extrachromosomallywithin the cell line and/or may be integrated into the cells'chromosomal DNA.

In a preferred embodiment, the mutant FVIII described herein are usedfor gene therapy of FVIII associated disorders, such as hemophilia A. Inthis case, expression of the mutant FVIII transgene can enhance clottingin a subject otherwise vulnerable to uncontrolled bleeding due to factorVIII deficiency (e.g., intraarticular, intracranial, or gastrointestinalhemorrhage), including hemophiliacs who have developed antibodies tohuman factor VIII. The target cells of the vectors are cells capable ofexpressing polypeptides with FVIII activity, such as those of thehepatic system of a mammal, endothelial cells and other cells with theproper cellular machinery to process the precursor to yield protein withFVIII activity.

In particular embodiments, the present invention provides apharmaceutical composition comprising a vector of the present inventionincluding a modified gene of FVIII in a pharmaceutically-acceptablecarrier and/or other medicinal agents, pharmaceutical agents, carriers,adjuvants, diluents, etc.

The treatment dosages of recombinant factor VIII that should beadministered to a patient in need of such treatment will vary dependingon the severity of the factor VIII deficiency. Generally, dosage levelis adjusted in frequency, duration, and units in keeping with theseverity and duration of each patient's bleeding episode. Accordingly,the recombinant factor VIII is included in a pharmaceutically acceptablecarrier, delivery vehicle, or stabilizer in an amount sufficient todeliver to a patient a therapeutically effective amount of the proteinto stop bleeding, as measured by standard clotting assays.

Factor VIII is classically defined as that substance present in normalblood plasma that corrects the clotting defect in plasma derived fromindividuals with hemophilia A. The coagulant activity in vitro ofpurified and partially-purified forms of factor VIII is used tocalculate the dose of recombinant factor VIII for infusions in humanpatients and is a reliable indicator of activity recovered from patientplasma and of correction of the in vivo bleeding defect. There are noreported discrepancies between standard assay of novel factor VIIImolecules in vitro and their behavior in the dog infusion model or inhuman patients, according to Lusher, et al., New Engl. J. Med.328:453-459 (1993); Pittman, et al., Blood 79:389-397 (1992); andBrinkhous, et al., Proc. Natl. Acad. Sci. 82:8752-8755 (1985).

Usually, the desired plasma factor VIII activity level to be achieved inthe patient through administration of the recombinant factor VIII is inthe range of 30-200% of normal. In one embodiment, administration of thetherapeutic recombinant factor VIII is given intravenously at apreferred dosage in the range from about 5 to 500 units/kg body weight,and particularly in a range of 10-100 units/kg body weight, and furtherparticularly at a dosage of 20-40 units/kg body weight; the intervalfrequency is in the range from about 8 to 24 hours (in severely affectedhemophiliacs); and the duration of treatment in days is in the rangefrom 1 to 10 days or until the bleeding episode is resolved. See, e.g.,Roberts, H. R., and M. R. Jones, “Hemophilia and RelatedConditions—Congenital Deficiencies of Prothrombin (Factor II, Factor V,and Factors VII to XII),” Ch. 153, 1453-1474, 1460, in Hematology,Williams, W. J., et al., ed. (1990). Patients with inhibitors mayrequire a different amount of recombinant factor VIII than theirprevious form of factor VIII. For example, patients may require lessrecombinant factor VIII because of its higher specific activity than thewild-type VIII and its decreased antibody reactivity. As in treatmentwith human or plasma-derived factor VIII, the amount of therapeuticrecombinant factor VIII infused is defined by the one-stage factor VIIIcoagulation assay and, in selected instances, in vivo recovery isdetermined by measuring the factor VIII in the patient's plasma afterinfusion. It is to be understood that for any particular subject,specific dosage regimens should be adjusted over time according to theindividual need and the professional judgment of the personadministering or supervising the administration of the compositions, andthat the concentration ranges set forth herein are exemplary only andare not intended to limit the scope or practice of the claimedrecombinant factor VIII.

Treatment can take the form of a single intravenous administration ofthe recombinant factor VIII or periodic or continuous administrationover an extended period of time, as required. Alternatively, therapeuticrecombinant factor VIII can be administered subcutaneously or orallywith liposomes in one or several doses at varying intervals of time.

For injection, the carrier will typically be a liquid. For other methodsof administration, the carrier may be either solid or liquid. Forinhalation administration, the carrier will be respirable, and willpreferably be in solid or liquid particulate form. As an injectionmedium, it is preferred to use water that contains the additives usualfor injection solutions, such as stabilizing agents, salts or saline,and/or buffers.

Exemplary pharmaceutically acceptable carriers include sterile,pyrogen-free water and sterile, pyrogen-free, phosphate buffered saline.Physiologically-acceptable carriers include pharmaceutically-acceptablecarriers. Pharmaceutically acceptable carriers are those which are thatis not biologically or otherwise undesirable, i.e., the material may beadministered to a subject without causing undesirable biological effectswhich outweigh the advantageous biological effects of the material. Apharmaceutical composition may be used, for example, in transfection ofa cell ex vivo or in administering a viral vector or cell directly to asubject.

Recombinant virus vectors comprising the modified gene of FVIII arepreferably administered to the cell in a biologically-effective amount.If the virus vector is administered to a cell in vivo (e.g., the virusis administered to a subject as described below), abiologically-effective amount of the virus vector is an amount that issufficient to result in transduction and expression of the transgene ina target cell.

The cells transduced with a viral vector are preferably administered tothe subject in a “therapeutically-effective amount” in combination witha pharmaceutical carrier. Those skilled in the art will appreciate thatthe therapeutic effects need not be complete or curative, as long assome benefit is provided to the subject.

Dosages of the cells to administer to a subject will vary upon the age,condition and species of the subject, the type of cell, the nucleic acidbeing expressed by the cell, the mode of administration, and the like.Typically, at least about 10² to about 10⁸, preferably about 10³ toabout 10⁸ cells, will be administered per dose. Preferably, the cellswill be administered in a therapeutically-effective amount.

Administration of the vector to a human subject or an animal in needthereof can be by any means known in the art for administering virusvectors. Exemplary modes of administration include rectal, transmucosal,topical, transdermal, inhalation, parenteral (e.g., intravenous,subcutaneous, intradermal, intramuscular, and intraarticular)administration, and the like, as well as direct tissue or organinjection, alternatively, intrathecal, direct intramuscular,intraventricular, intravenous, intraperitoneal, intranasal, orintraocular injections. Injectables can be prepared in conventionalforms, either as liquid solutions or suspensions, solid forms suitablefor solution or suspension in liquid prior to injection, or asemulsions. Alternatively, one may administer the virus in a local ratherthan systemic manner, for example, in a depot or sustained-releaseformulation.

In other preferred embodiments, the inventive vector comprising themutant FVIII gene is administered intramuscularly, more preferably byintramuscular injection or by local administration. The vectorsdisclosed herein may be administered to the lungs of a subject by anysuitable means, but are preferably administered by administering anaerosol suspension of respirable particles comprised of the inventiveparvovirus vectors, which the subject inhales. The respirable particlesmay be liquid or solid. Aerosols of liquid particles comprising theinventive parvovirus vectors may be produced by any suitable means, suchas with a pressure-driven aerosol nebulizer or an ultrasonic nebulizer,as is known to those of skill in the art. See, e.g., U.S. Pat. No.4,501,729.

Dosages of the virus vector with the mutant FVIII gene will depend uponthe mode of administration, the disease or condition to be treated, theindividual subject's condition, the particular viral vector, and thegene to be delivered, and can be determined in a routine manner.Exemplary doses for achieving therapeutic effects are virus titers of atleast about 10⁵, 10⁶, 10⁷ 10⁸, 10⁹, 10¹⁰, 10¹¹, 10¹², 10¹³, 10¹⁴, 10¹⁵transducing units or more, preferably about 10⁸-10¹³ transducing units,yet more preferably 10¹² transducing units. The mutant FVIII genes maybe administered as components of a DNA molecule having regulatoryelements appropriate for expression in the target cells. The mutantFVIII genes may be administered as components of viral plasmids, such asrAAV vectors. Viral particles may be administered as viral particlesalone, whether as an in vivo direct delivery to the portal vasculatureor as an ex vivo treatment comprising administering the vector viralparticles in vitro to cells from the animal receiving treatment followedby introduction of the transduced cells back into the donor.

The present invention is further illustrated by the following exampleswhich should not be construed as limiting. The contents of allreferences, patents, and published patent applications cited throughoutthis application are incorporated herein by reference.

Example 1: Construction, Expression and Purification of B-DomainlessFactor VIII Mutants

Plasmid pAAV-CB-F8 carries a B-domainless human factor VIII (hF8) cDNAunder the control of a CB promoter (beta-actin promoter with a CMVenhancer). This plasmid, consistent with the construction shown in FIG.10, was used as template for making various hF8 mutants. A hF8 cDNAfragment encoding the substitution mutations I86V, Y105F, A108S, D115E,Q117H, F129L, G132K, H134Q, M147T and L152P was synthesized chemicallyand used to replace the corresponding region of pAAV-CB-F8. Theresulting plasmid (pAAV-CB-F8-X10) expresses a mutant factor VIIIprotein with the above 10 mutations (F8-X10; SEQ ID NO: 3).

A factor VIII cDNA fragment encoding the substitution mutations I86V,A108S, G132K, M147T, L152P was synthesized chemically and used toreplace the corresponding region of pAAV-CB-F8. The resulting plasmid(pAAV-CB-F8-X5) expresses a mutant factor VIII protein with the above 5mutations (F8-X5; SEQ ID NO:4).

Site-directed mutagenesis was used to introduce individual mutationscorresponding to I86, Y105, A108, D115, Q117, F129, G132, H134, M147,L152 of human factor VIII in the pAAV-CB-F8 plasmid. The resultingplasmids include pAAV-CB-F8-I86V, pAAV-CB-F8-Y105F, pAAV-CB-F8-A108S,pAAV-CB-F8-D115E, pAAV-CB-F8-Q117H, pAAV-CB-F8-F129L, pAAV-CB-F8-G132K,pAAV-CB-F8-H134Q and pAAV-CB-F8-M147T, pAAV-CB-F8-L152P.

Site-directed mutagenesis was also used to revert back individualmutations in amino acids 86, 105, 108, 115, 117, 129, 132, 134, 147, 152of hF8-X10 in the pAAV-CB-F8-X10 plasmid to wild-type human amino acids.The resulting plasmids include pAAV-CB-F8-X10-V861,pAAV-CB-F8-X10-F105Y, pAAV-CB-F8-X10-S108A, pAAV-CB-F8-X10-E115D,pAAV-CB-F8-X10-HI17Q, pAAV-CB-F8-X10-L129F, pAAV-CB-F8-X10-K132G,pAAV-CB-F8-X10-Q134H, pAAV-CB-F8-X10-T147M, pAAV-CB-F8-X10-P152L. Thesemutants were tested as described Example 4 (FIG. 7) below.

A set of degenerated oligonucleotides with NNN corresponding to G132position was used to create all 19 mutations corresponding to G132. Theresulting factor VIII mutant plasmids include pAAV-CB-F8-G132A,pAAV-CB-F8-G1321, pAAV-CB-F8-G132V etc. The last letter indicates theamino acid substitution at that particular position. A similar strategycan be used to generate other substitutions in accordance with thepresent invention.

The above described plasmids contain an AAV-ITR and can be used togenerate AAV vectors. A liver specific promoter can be used to replacethe CB promoter to reduce the size of the expression cassette and toimprove vector packaging and expression in the liver. Other tissuespecific promoter can also be used as well.

Sequences between the FVIII heavy chain and the FVIII stop codon wereremoved from the FVIII expression vectors. The resulting heavy chain(HC) mutants contain the first 745 amino acid of FVIII and lack B domain(BDD) and light chain (LC) sequences. The plasmid pAAV-CB-HC-X10contains mutations corresponding to I86V, Y105F, A108S, D115E, Q117H,F129L, G132K, H134Q, M147T and L152P in the heavy chain. The plasmidpAAV-CB-HC-X5 contains mutations corresponding to I86V, A108S, G132K,M147T, L152P in the heavy chain. The plasmid pAAV-CB-HC-G132K containsthe G132K mutation in the heavy chain. Alternatively, acidic region 3(a3) can be added to these constructs to obtain HC mutants in an HC1690background.

Example 2: Comparison of Different Factor VIII Mutants for Secretion inTissue Culture Cells

Plasmids pAAV-CB-hBDD-F8 (wt), pAAV-CB-hBDD-F8-X10, pAAV-CB-hBDD-F8-X5and pAAV-CB-hBDD-F8-G312K were separately transfected in BHK cells(panel A) or 293 cells (panel B). Secreted F8 in the media was harvestedand assayed by aPTT assay at 48 hours post transfection. Theexpression/secretion by wild type human BDD-F8(hBDD) was set as 100%. Asshown in FIG. 7, the hF8 mutants were secreted at about 2-8.5 foldhigher expression levels than the wild type hF8.

Example 3: Comparison of Human Factor VIII Mutant Secretion In Vivo

Plasmids pAAV-CB-hBDDF8 (B-domain deleted (BDD) wt hF8),pAAV-CB-hBDDF8-X10 (hF8-BDD with 10 substitutions; SEQ ID NO:3),pAAV-CB-hBDD-F8-X5(hF8 with 5 substitutions; SEQ ID NO:4) andpAAV-CB-hBDD-F8-G312K (hF8 with G132K substitution) were separatelyinjected to Balb/c and F8 double knock-out mice. Secreted F8 in theblood was collected and assayed by aPTT assay at 48 hours postinjection. The expression/secretion by wild type human F8 (hBDD-F8) wasset as 100%. All mutants described here outperform the wild type factorVIII. As shown in FIG. 8, the hF8 mutants were secreted at about 1.2-5.2fold higher expression levels than the wild type hF8.

Example 4: Comparison of Different Factor VIII Mutants in Secretion

Plasmids encoding amino acids in hBDD-F8-X10 were modified to revertback the mutant substitutions to their corresponding wild type aminoacids as indicated in the table. For example, hBDD-F8-X10-V861 meansthat “V86” in hBDD-F8-X10 was changed back to “I”. In hBDD-F8-X10-6p, 6of 10 mutant amino acids in hBDD-F8-X10 were reverted back to theircorresponding wild type amino acids. The above plasmids were separatelytransfected in 293 cells. Secreted F8 in the media was harvested andassayed by aPTT assay at 48 hours post transfection. Theexpression/secretion by hBDD-F8-X10 was set as 100%. As shown in FIG. 9,all of the revertants exhibited reduced expression and secretion ascompared to the hBDD-F8-X10 mutant.

Example 5: Comparison of Different Factor VIII Mutants in Secretion

AAV8 vector AAV-apoEhAAT-hF8HC1690 (carrying human factor VIII heavychain aa#1-745 and a3 sequence, apoEhAAT: human alpha one antitrypsinpromoter with apo E enhancer) and AAV-apoEhAAT-hF8-HC-X10 (hF8HC with 10substitutions) were each separately injected in F8 knock-out mice with alight chain expression vector (dose: each vector 1E11 particles/mouse).Secreted F8 in the blood was collected and assayed by aPTT assay theindicated times. The expression/secretion by wild type human F8 heavychain (hF8-HC1690) was set as 100%. The hF8-HC1690-X10 mutant describedhere outperform the wild type heavy chain expression. As shown in FIG.10, the hF8-HC1690-X10 mutant was secreted at about 6-20 fold higherexpression levels compared to wild type hF8HC.

Example 6: Comparison of G132 Factor VIII Heavy Chain Mutants inSecretion in 293 Cells

Plasmid pAAV-CB-hF8-HC1690 (carrying human factor VIII heavy chainaa#1-745 and a3 sequence; see FIG. 1) or plasmids with indicatedsubstitutions at G132 were transfected in 293 cells with an F8 lightchain (LC) expression plasmid. Secreted F8 in the media was collectedand assayed by aPTT assay at 48 hours post transfection. Theexpression/secretion by wild type human F8 heavy chain (hF8-HC1690) wasset as 100%. As shown in FIG. 11, the F8 G132HC1690 mutants weresecreted at about 1.4-3.4 fold higher expression levels compared to wildtype hF811C.

Example 7: Comparison of Different Factor VIII Heavy Chain Mutants inExpression/Secretion In Vivo

Plasmids pAAV-CB-hF8-IIC1690 (carrying human factor VIII heavy chainaa#1-745 and acidic region 3 (a3) sequence; see FIGS. 1, 6),pAAV-CB-hF8-HC1690-X10 (hF8 heavy chain with 10 substitutions; SEQ IDNO:5), pAAV-CB-hF8-HC1690-X5 (hF8 heavy chain with 5 substitutions alongwith a3 sequence; SEQ ID NO:6) and pAAV-CB-hF8-HC1690-G312K (hF8 heavychain with G132K substitution and a3 sequence) were separately injectedin Balb/c and F8 double knock-out mice along with a light chainexpression plasmid. Secreted F8 in the blood was collected and assayedby aPTT assay at 48 hours post injection. The expression/secretion bywild type human F8 heavy chain (hF8-HC1690) was set as 100%. As shown inFIG. 12, the hF8 mutants were secreted at about 2.5-4.5 fold higherexpression levels than the wild type hF8HC.

Example 8: Comparison of L152 Factor VIII Heavy Chain Mutants inSecretion in 293 Cells

Plasmid pAAV-CB-hF8-HC1690 (carrying human factor VIII heavy chainaa#1-745 and a3 sequence; see FIGS. 1, 6) or plasmids with indicatedsubstitutions at L152 were separately transfected in 293 cells with ahF8 light chain expression plasmid. Secreted hF8 in the media wascollected and assayed by aPTT assay at 48 hours post transfection. Theexpression/secretion by wild type human F8 heavy chain (hF8-HC1690) wasset as 100%. The hF8-L152HC mutants are identified by their specificamino acid substitutions in the Figure. As shown in FIG. 13, thehF8-L152HC mutants were secreted at about 1.4-3.5 fold higher expressionlevels compared to wild type hF8HC

Example 9: Comparison of A108 Factor VIII Heavy Chain Mutants inSecretion in 293 Cells

Plasmid pAAV-CB-hF8-HC1690 (carrying human factor VIII heavy chainaa#1-745 and a3 sequence; see FIG. 1) or plasmids with indicatedsubstitutions at A108 were separately transfected in 293 cells with ahF8 light chain expression plasmid. Secreted hF8 in the media wascollected and assayed by aPTT assay at 48 hours post transfection. ThehF8-A108HC mutants are identified by their specific amino acidsubstitutions in the Figure. The expression/secretion by wild type humanF8 heavy chain (hF8-HC1690) was set as 100%. As shown in FIG. 14, themajority of hF8-A108HC mutants were secreted at higher expression levelscompared to wild type hF8HC.

Example 10: Comparison of M147 Factor VIII Heavy Chain Mutants inSecretion in 293 Cells

Plasmid pAAV-CB-hF8-HC1690 (carrying human factor VIII heavy chainaa#1-745 and a3 sequence; see FIG. 1) or plasmids with indicatedsubstitutions at M147 were separately transfected in 293 cells with ahF8 light chain expression plasmid. Secreted hF8 in the media wascollected and assayed by hF8 ELISA at 48 hours post transfection. ThehF8-M147HC mutants are identified by their specific amino acidsubstitutions in the Figure. The expression/secretion by wild type humanF8 heavy chain (hF8-HC1690) was set as 100%. As shown in FIG. 15, themajority of hF8-M1471-IC mutants were secreted at higher expressionlevels compared to wild type hF8HC.

Example 11: Neutralizing Antibodies Against 5 Mutated Amino Acids werenot Detected in the F8−/− Rat Model

F8−/− rats in a WAG/RijYcb background with single mutation in the A1domain (Leu176Pro) were administered AAV-TTR-hF8-X10 at 1×10¹² viralparticles/per rat. Of 3 injected rats, two were confirmed to develop ratanti-human factor VIII inhibitory antibodies against factor VIII asdetermined by a Bethesda assay. Panel A is representative of inhibitorlevels in rat plasma at week 8. Panel B shows the activity of F8 remainsin the supernatant after antibody absorption. To determine whether theinhibitory antibodies specifically target the 5 mutated amino acids, weused an excess of biotinylated recombinant human F8 (1.2 1.tg of Bio-F8)to saturate the inhibitory antibodies against regular FVIII in ratplasma. Then 30 1.1.1 of streptavidin agarose was used to pull downantigen-antibody complexes by rotation at room temperature for 1 hourand then centrifuged at 10,000 rpm for 2 min. An equivalent amount ofbiotinylated BSA (Bio-BSA) was used as a control. 200 ng of BDD-F8-X5concentrate from a stably expressing cell line was then added to the ratplasma pretreated with Bio-F8 or Bio-BSA. Rat plasma withoutpretreatment was used as control. The F8 activity in the supernatant wasdetermined by one-stage aPTT assay. As shown in FIG. 15, neutralizingantibodies against the five mutated amino acids were not detected inthis F8−/− rat model.

The above Examples show that the mutant factor VIII products of thepresent invention express and/or secrete better than wild type factorVIII, therefore they can decrease the production cost and improvetransgene expression levels when using a gene transfer vector. They canalso allow lower vector doses to be administered and higher factor VIIIexpression levels.

The above description is for the purpose of teaching a person ofordinary skill in the art how to practice the present invention. It isnot intended to detail all those obvious modifications and variations ofit which will become apparent to the skilled worker upon reading thedescription. It is intended, however, that all such obviousmodifications and variations be included within the scope of the presentinvention, which is defined by the following claims. The claims areintended to cover the claimed components and steps in any sequenceeffective to meet the objectives there intended, unless the contextspecifically indicates the contrary.

1-63. (canceled)
 64. An isolated polynucleotide encoding a polypeptide,wherein the polypeptide comprises wildtype human factor VIII with one ormore amino acid substitution(s) at positions I86, Y105, A108, D115,Q117, F129, G132, H134, M147 and/or L152.
 65. The isolatedpolynucleotide of claim 64, wherein the amino acid substitutions areselected from the group consisting of I86V, I86L, I86M, Y105F, Y105W,A108S, A108G, A108T, A108P, D115E, D115N, D115H, D115Q, D115R, D115K,Q117H, Q117N, Q117E, Q117D, Q117R, Q117K, F129L, F129V, F1291, F129M,F129P, F129T, F129K, G132K, G132E, G132D, G132R, G132T, G132M, G132N,G132S, G132W, H134Q, H134G, H134Y, H134N, H134E, H134D, H134R, H134K,M147T, M147A, M147G, M147S, M147P, L152P, L152S, L152G and L152T. 66.The isolated polynucleotide of claim 64, wherein the polypeptidecomprises amino acid substitutions A108S, M147T, and L152P.
 67. Theisolated polynucleotide of claim 65, wherein the amino acidsubstitutions are selected from the group consisting of I86V, Y105F,A108S, D115E, Q117H, F129L, G132K, H134Q, M147T and L152P.
 68. Theisolated polynucleotide of claim 66, wherein the polypeptide comprisesthe amino acid substitution I86V.
 69. The isolated polynucleotide ofclaim 65, wherein the amino acid substitutions are selected from thegroup consisting of I86V, A108S, G132K, M147T and L152P.
 70. Theisolated polynucleotide of claim 65, wherein the amino acidsubstitutions are selected from the group consisting of A108S, M147T,and L152P.
 71. The isolated polynucleotide of claim 70, wherein thepolypeptide further comprises amino acid substitutions I86V and G132K.72. The isolated polynucleotide of claim 64, wherein the polypeptidecomprises a deletion in the B domain.
 73. The isolated polynucleotide ofclaim 64, wherein the polypeptide comprises the a2 and/or a3 domain(s)of human factor VIII.
 74. An isolated polynucleotide comprising SEQ IDNO: 1, wherein the polynucleotide encodes a human factor VIIIpolypeptide comprising one or more amino acid substitution(s) atpositions I86, Y105, A108, D115, Q117, F129, G132, H134, M147 and/orL152.
 75. The isolated polynucleotide of claim 74, wherein the aminoacid substitutions are selected from the group consisting of I86V, I86L,I86M, Y105F, Y105W, A108S, A108G, A108T, A108P, D115E, D115N, D115H,D115Q, D115R, D115K, Q117H, Q117N, Q117E, Q117D, Q117R, Q117K, F129L,F129V, F1291, F129M, F129P, F129T, F129K, G132K, G132E, G132D, G132R,G132T, G132M, G132N, G132S, G132W, H134Q, H134G, H134Y, H134N, H134E,H134D, H134R, H134K, M147T, M147A, M147G, M147S, M147P, L152P, L152S,L152G and L152T.
 76. The isolated polynucleotide of claim 75, whereinthe amino acid substitutions are selected from the group consisting ofI86V, Y105F, A108S, D115E, Q117H, F129L, G132K, H134Q, M147T and L152P.77. The isolated polynucleotide of claim 74, wherein the polypeptidecomprises a deletion in the B domain.
 78. An expression vectorcomprising the polynucleotide of claim
 64. 79. A host cell comprisingthe polynucleotide of claim
 64. 80. A host cell comprising theexpression vector of claim
 79. 81. A pharmaceutical compositioncomprising the expression vector of claim
 80. 82. A method for treatinga patient with a factor VIII deficiency comprising: administering to thepatient in need thereof the pharmaceutical composition of claim 81 in anamount effective for treating the factor VIII deficiency.
 83. A methodfor expressing a human factor VIII polypeptide mutant comprising: (a)transforming a host cell with an expression vector comprising thepolynucleotide of claim 64; (b) growing the host cell under conditionssuitable for expressing the human factor VIII polypeptide mutant; and(c) purifying the human factor VIII polypeptide mutant from host cellsexpressing said mutant.